Then There Was One: The unraveling of Catholic health care

Then There Was One: The unraveling of Catholic health care

In 2007 there were eight Catholic acute care hospitals in New York City. By the end of 2008 there was only one. The reasons for this shift are many and complex, but it would be foolish to dismiss this as a freak event, unique to that city. Indeed, even if one has no special interest in the field of health care, this story speaks volumes about the current state of Catholic institutions in the United States. How did so much happen so fast? And what can be learned?

In the 1990s, fearing increased pressure to conform to secular medical morality and under intense financial stress from managed care, Cardinal John O’Connor of the Archdiocese of New York pushed the somewhat unwilling hospitals and nursing homes of the archdiocese into a loose confederation called the Catholic Health Care Network. Initial plans were for a full merger, but fear on the part of the hospitals that their charisms would be lost and worries about job security on the part of administrators scuttled the effort.

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Unable to merge completely with the hospitals of the Catholic Health Care Network, and facing mounting financial difficulties, St. Vincent’s Hospital Manhattan explored a possible merger with St. Vincent’s Staten Island and the hospitals of the Diocese of Brooklyn, which had been united into one network as early as the 1960s. This too, proved difficult. Brooklyn feared that in a three-way merger they would face a two-against-one dynamic. While St. Vincent’s Manhattan was owned by the Archdiocese of New York, and St. Vincent’s Staten Island by the Sisters of Charity, the religious congregation itself was an order of the Archdiocese of New York. This could provide the archdiocese with an unfair advantage. To facilitate a bilateral structure, Cardinal O’Connor ceded full control of St. Vincent’s Manhattan back to the Sisters of Charity, and the merger proceeded. A number of members of the board of trustees of St. Vincent’s Manhattan warned that the undertaking was ill advised and expressed skepticism about the financial health of the Brooklyn hospitals. Nevertheless in 2000 the merger was completed and the Saint Vincent Catholic Medical Centers of New York was created.

The chief executive officers and boards of trustees of all the merging institutions were replaced with a new board—consisting of two members of the Sisters of Charity, an auxiliary bishop and a canon lawyer— and a new C.E.O. from the outside with experience running a big system and a history, albeit a highly checkered one, of overseeing mergers.

The Bottom Drops Out

From the moment of its creation, Saint Vincent Catholic Medical Centers of New York was a disaster. The problems of a $1.6 billion-a-year multi-hospital, multi-nursing-home behemoth were legion. As it turned out, the Brooklyn hospitals were in horrible financial shape. Two hundred million dollars in cash reserves (a meager amount by health care standards) went out from St. Vincent’s Manhattan into Brooklyn as soon as the merger took place. Staff in Brooklyn, who had no idea that their hospitals were in such bad shape, immediately blamed Manhattan for mismanagement. Manhattan physicians placed the blame for the financial instability of their hospital on Brooklyn, despite the fact that St. Vincent’s Manhattan was hemorrhaging cash independently. And financially solvent Brooklyn nursing homes resented having to carry the load for the hospitals.

Professional relationships did not function properly, either. The physicians refused to refer patients to one another or to function as one system. Attempts to create systemwide bylaws bogged down in endless squabbles.

After Sept. 11, 2001, a decline in the number of employees and residents of downtown Manhattan dramatically reduced the potential patient population around St. Vincent’s, and the hospital incurred huge losses. Despite the hospital’s national prominence in the wake of the terrorist attacks on Sept. 11, no one proved able to make effective use of it to raise funds. When post-9/11 federal dollars were doled out, New York hospitals that had played almost no role in responding to the disaster received more funding than did St. Vincent’s.

The financial picture continued to deteriorate. The economies of scale that the merger was supposed to achieve were poorly realized. Saint Vincent Catholic Medical Centers wound up with the worst managed-care contracts in the city. The system could not pay its creditors; it deferred maintenance and the floors went unwashed. On several occasions the institution came close to missing its payroll obligations. Layoffs included physicians, and essential items like X-ray film became scarce when suppliers imposed credit-holds.

The four trustees, however, did not see that the man they had hired to run the new system was incompetent. While he justified the network’s problems as endemic to health care generally and called for more consultants, the budget for the system’s corporate offices ballooned. Finally, in 2004 the C.E.O. was fired.

Survival came at a still higher price. Saint Vincent Catholic Medical Centers declared Chapter 11 bankruptcy in 2005; when it emerged from bankruptcy in 2007, large chunks of Manhattan real estate that had provided office space, housing for residents and students and a convent for the sisters had been sold, along with three of the hospitals. Worse still, the hospitals located in the poorest neighborhoods had to be closed; no one wanted to buy them.

In the meantime, under the leadership of a new prelate who had inherited a financially troubled system, the Archdiocese of New York was busy extricating itself entirely from the acute-care hospital business. Our Lady of Mercy Hospital was sold to Montefiore in 2008. Operation of the former St. Clare’s was ceded to St. Vincent’s Manhattan in 2003; it continued to operate until it was finally closed in 2007 by the state’s Berger Commission, which had been established to reorganize and streamline health care throughout the state. The commission also shut down Cabrini Medical Center, another financially ailing Catholic acute care hospital in Manhattan.

And then there was one: St. Vincent’s Hospital Manhattan.

What Went Wrong?

Mergers often fail because of inattention to differences in culture between the merging institutions. That was clearly true in this case. Beyond this generic issue, however, what observations can be made? Why did the Catholic hospital system in New York City collapse so rapidly? Several lessons emerge.

1. The marketplace is a harsh environment for faith-based institutions. New York is one of the world’s most high-cost, inefficient cities for health care delivery. The average New York City family spends 18 percent more cost-of-living-adjusted dollars on health care than does the average American. A New Yorker is also 45 percent more likely to be X-rayed than a patient in Seattle.

To reduce costs, managed care used the same major technique in New York that it had used nationally: it forced shorter hospital stays. As a result, New York City eventually had many unused hospital beds. Rather than close, however, all of the city’s hospitals (except the university hospitals) tried to stay afloat by shrinking. The competition for paying patients and for the physicians who admit paying patients became fierce. Such a cutthroat commercial environment sits uneasily with a mission-based approach to care.

Moreover, consistent with their missions, Catholic hospitals were often built in poor neighborhoods. Medicaid cutbacks and an increasing burden of care for undocumented immigrants meant even less income; the financial stress proved too much.

Yet it is possible to hold one’s own without selling one’s soul. In other places during this era of managed care, Catholic and non-Catholic hospital systems still serve the poor and flourish. Some Catholic institutions have joined relatively well-paying suburban hospitals to inner-city hospitals, and in so doing are able to balance their losses with gains. As Jesus said, we must be wise as serpents and as innocent as doves.

2. Catholic philanthropy is weak. Surviving intense market competition and financial stress often requires generous but wise philanthropic support. New York’s Catholic hospitals saw precious little support, even when philanthropy elsewhere was robust. New York’s Mount Sinai Hospital, for instance, was in deep financial trouble in 2001 with an operating loss of $26 million. But after asking for and receiving enormous philanthropic support, they made a complete turnaround.

Today many Catholics have risen to prominence and have amassed great wealth. Catholic philanthropy, however, while often generous to direct service projects, does much less to support educational, cultural and health care institutions. Catholic universities and hospitals are notoriously under-endowed compared with similar institutions. It is a great irony: Catholics complain that they do not influence culture, but when they have the resources to make a difference, they tend not to support the institutions that can achieve such influence.

3. Catholics operate under outdated institutional assumptions. In the 1950s loyalty and subservience could be valued over competence, and institutions would still survive. In today’s complex environment, however, this is no longer true. Perhaps New York’s Catholic hospitals failed, in part, because too many of the administrators hired were good Catholics rather than good managers.

In some parts of the country, religious orders, conscious of their declining numbers, started years ago to plan for leadership succession in their institutions, truly “forming” lay leaders in their charisms, creating a knowledgeable and dedicated leadership workforce. New York’s Catholic health care institutions, unfortunately, operated as if the sisters would always be there. As a result, the sisters were relegated to being spectators when disaster struck.

An outmoded, 1950s-style Catholic parochialism continues to plague Catholic institutions. Catholics were afraid to engage with non-Catholic institutions, religious orders were wary of other religious orders, and each diocese was wary of the other. The collapse that followed illustrates quite clearly: If we cannot work together, we will all die alone.

4. Catholics are opting for secular values. Exceedingly few people, including Catholics, seem to have noticed that there has been an 89 percent reduction in the number of Catholic hospitals in New York City in a very short period of time. I suspect one reason is that Catholics no longer prize Catholic institutions. This is partly good. Many Catholic institutions were founded because Catholics could not break through barriers of prejudice. As Catholics have become part of the mainstream, they no longer need such institutions for access to services.

But something has also been lost—a culture, a spirit and a community of faith. In a consumer society, people seek the best brand. Parents who once sent their children to Fordham now send them to Harvard. Even Cardinal O’Connor, when diagnosed with a brain tumor in 1999, sought care at Memorial Sloan Kettering rather than at St. Vincent’s Comprehensive Cancer Center. Medically, Memorial offered nothing that St. Vincent’s could not have offered for his cancer, but St. Vincent’s could have offered also a spiritual atmosphere and approach to palliative care that Memorial cannot match. Excellence and compassion are not antithetical. Catholic institutions can offer both in a truly distinctive way.

5. Ecclesiastical culture can be enervating. The hospital crisis could have been a time for a robust display of ecclesiastical leadership. Unfortunately, none was forthcoming. It seems that in the current ecclesiastical climate, one succeeds not by one’s accomplishments but by not making mistakes. Hospitals are costly and can drain enormous amounts of time. They can also spell trouble if someone in a Catholic hospital does something that some group thinks is a violation of church teaching. In such an environment, there is little incentive for church leaders concerned about their own future to take a decisive role.

6. Catholic institutions often have poor political connections. When hospitals looked for relief after 9/11, when market pressures pushed all hospitals to the brink of disaster, when the Berger Commission decided which hospitals to close, Catholic hospitals in New York consistently fared poorly. A major reason was the loss of Catholic political power in the city and state. Because of the influence of unions and local neighborhood political power, it was politically impossible to close any of New York’s 11 city-owned hospitals. And no one would dare close the big university hospitals. What remained were the small to mid-sized private hospitals. Those without political clout (for the most part, that meant the Catholic hospitals) were the most vulnerable.

Why Bother?

Some might wonder why one should bother to save Catholic institutions. Perhaps the time has come to abandon bricks-and-mortar Catholicism and instead to live the faith by blending like yeast into the secular society. Personally, despite all the obstacles, I continue to be convinced that Catholic institutions (and, in particular, Catholic hospitals) are worth fighting to save. Catholic institutions help to nourish the faith of those who work in them and are served by them. Our Catholic hospitals also provide a vehicle for proving that our moral convictions are compatible with 21st-century technology, and they embody the ideal that service institutions ought to have service missions. In health care, patients and practitioners alike are becoming alienated from the health care delivery system. Hospitals that treat patients with true respect, recognize their dignity, attend to their spiritual needs, value people over technology and value service over the bottom line are precisely the remedy that people need. Given their mission, Catholic institutions should be leading the way.

Institutional presence also brings with it a place at the political table and greater potential to lobby for the good. A bishop who can say that Catholics operate one-third of the hospital beds in his state is much more likely to be heard on health care justice for the poor, than if he is speaking from the sidelines.

Recently St. Vincent’s tended survivors from the US Airways jet that went down in the Hudson River, just as it had tended survivors from the Titanic in 1912, survivors from the Lusitania in 1915 and survivors from the World Trade Center attacks of 1993 and 2001. Located in the heart of our communities and serving us often in the circumstances when we are most in need, Catholic institutions are worth saving. But the story of what happened to health care in New York suggests we had better learn well, and quickly, if we wish to succeed.

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James Lindsay

9 years ago

Given the existence of an association of the same name, perhaps you could add the words "in New York" to the title.

9 years ago

A depressing article, but one badly needed. Yet unfortunately it seems not surprising that Catholic medical care been hurt by "outdated institutional assumptions," by the "envervating" qualities of episcopal culture and leadership, and of course, by the weakness of Catholic philanthropy. (That last did in fact surprise me; I had always heard that Catholic giving favored hospitals while ignoring universities and colleges they ignored. Now, I learn Catholic philanthropists ignore both.) Still, I wonder whether Dr. Sulmasy might not perhaps be extrapolating too much from NY's situation to the rest of the country? As a member of a local medical center board, I read recently (in Trustee) a glowing report of a large Catholic health care association (in the middle west, as I remember) that seemed to be doing everything right (not surprisingly under the leadership of a nun, I think). But of course I have no reference to the article's date and time, and I'm sure Dr. S. knows far, far more than I do about the sitution. Sorry not to be more help.

9 years ago

The author has written an insightful reflection on the condition of St. Vincent Hospital. I wonder, however, if the time has not come when the Catholic Hospital System should rethink its medical mission, downsizing it from the kind of institution that can compete, technologically,with other hospitals enjoying a stronger financial base, and devoting itself to meet the type of median health care needs that are the concern of the average Catholic person, and, indeed, of the average person at large.

Bonnie Jachowicz

9 years ago

I fear the day is rapidly approaching when Catholic obstetricians, nurses, and other conscientious medical personnel will not be able to continue in their profession without being told to perform abortions or assist with them. The current government administration seems eager to remove all barriers to readily available abortion services for women. Hospitals that resist this trend will not be paid for their services, no matter how expertly and compassionately they are rendered. The demise of Catholic hospitals in the United States would be a devastating loss of excellent medical care, Catholic medical-moral leadership, compassion, and needed service to the poor.

Daniel Callahan

9 years ago

This is an excellent article, it is indeed sad that the Catholic Healthcare Tradition of delivering witness to the value of life must come to an end because of the fiscal realities and market disincentives that come to bear on what has become now more simply a business than a ministry. Perhaps it is time to shake the dust from our feet at these ventures and place our energies and resources where they may be employed to proclaim gospel values more effectively.

9 years ago

Dr. Sulmasy, Thank you for the articulate observations in your article. As a Catholic physician, administrator and healthlaw attorney there are two points I wanted to address supporting your article. 1. In addressing the question of "why bother?", I think perhaps the most important reason to "bother" is that healthcare is the third leg of the trinity of Christ's Missions along with His apostolic and educational charges to the Church. Thus the answer to "why bother" is that Christ Himself charged us as Catholics with this Mission. Another reason, which I believe you implied, but to supplement explicitly is that Catholic Healthcare is DIFFERENT than secular healthcare. We are charged by Mission to attend to the spirit, mind and body of our patients, the trinity of our humanity if you will. I firmly believe that just as the Church was the refuge of knowledge in the dark ages, the Church manifested in Catholic Healthcare is the refuge of real "Health Care" (spirit/mind/body health care) in these difficult times in our world. 2. A second point of your article I would like to underscore is the dire need for substantial formation programs for Catholic Healthcare Leaders. I have seen poorly formed leaders selected for their "competence" and yes, I have seen that competence result in better bottom lines. But I have also observed the moral and ethical limitations of some such leaders and have been appalled that Catholic Healthcare Boards would make such a trade-off. I would end this comment by asking the author if it is any more appropriate to allow a supremely competent but poorly formed leader to lead catholic healthcare institutions than it would be to allow an unformed leader to head any of Christ's other two Missions? Would we select an unformed leader as the President of Notre Dame or allow an unformed leader to preside at Mass? As sisters and brothers religious exit from this Healthcare Mission it is imperative that, before they exit, they spend the time to form competent upcoming leaders properly to continue their work in Christ's Mission of Health Care.

9 years ago

Another fine example of Ignation scholarship. When did the use of facts, quotes, statistics, diverse and hopefully expert opinions cease? Here are some questions to consider: 1. What is the FACTUAL and STATISTICAL relationship between MEDICARE/MEDICAID, private insurance and fee based medical care? 2. Much like our Catholic universities, as orders and dioceses surrendered their leadership/management of hospitals to "lay boards" how do they retain their original charisms? Should they? 3. If healthcare is a "right" and is subsidized by the people, why have a parallel system? In other words, if the people, through their democratic institutions, pay for health care should the people have a say in the principles of health care? What if those principles are in conflict with Catholic principles? 4. One final point, the author writes, "I continue to be convinced that Catholic institutions (and, in particular, Catholic hospitals) are worth fighting to save. Catholic institutions help to nourish the faith of those who work in them and are served by them." Do they and how so? I did find this quote interesting, “Catholics are opting for secular values.”

9 years ago

You answered your own question. Who's at fault? The board of trustees. As with most "catholic" institutions somehow a bishop, a priest, canon lawyer are considered capable of running a financial institution. I have seen this many times before. Nurses who rise up and run hospitals need to do a great job in keeping things runnings. These nurses used to be sisters. But, then as usual some bishop decides to take over and next thing everything falls to pieces. Leadership and respect in who is running the show is as important as the resume. Sisters have always had to "work" for a living and know you cannot keep asking for a hand out. Bishops and priests on the other hand are from the "welfare state" and have no clue how to manage a budget. I have been on parish councils and diocesan planning committees. Each and every time, poor decisions are made by the guys with theology degrees. They have no clue and then make decisions that must not be questioned otherwise they rumor bad things about you. I saw beautifully grammer school in the black taken over by a parish pastor from a hard working sister. In less than a year, he spent not only the budget and teachers fund; but brought his "friends" cars. The sisters who complained to the "bishop" were sent off to punishment land. In summary, never ever appoint untrained and unschooled people to a board of trustees no matter how big they are.

David Pasinski

9 years ago

Thanks, Dr. Sulmasy, for another fine contribution. I am quite familiar with our strong and well beloved local Catholic hospital, but I'm sure there are some similar pressures there also. What particularly fascinates me at this time however, is the juxtaposition of this article with the publication of the data about the increased secularism and precipitously declining lack of identification with established traditions. What winds arr blowing throughout this nation and what is an authentic Catholic Chistian response to those in increasing need? Who will be like the foundresses of so many of these great -- if now fading or closed -- institutions? Catholic education on the grammar and high school levels nearly gone, health care declining... the answer is blowing in the wind...

9 years ago

A very interesting story but I draw completely different conclusions than the author. I see a parallel between the situation of Catholic health care institutions and the mounting financial struggles of Catholic elementary and high schools. I think it's time to question the value of these systems in light of contemporary reality. We're not an immigrant church and we don't have nuns who work for low wages anymore. And institutions cannot do what individuals should be accomplishing. In my experiences with hospitals, Catholic ones are not different. Yes, they have well-crafted missions, but not everyone on staff is capable of or even interested in living it out. It's time we realized that the parish is the fundamental entity of Catholicism and focused our resources there. A form of health care ministry and certainly education can be brought to life in that setting.

9 years ago

Thanks to Fr. Sulmasy for another fine analysis. The events in New York are shocking, but he does enumerate some of the causes -- in particular, our failure to form a new generation of leaders. I work full time in board formation for another Catholic health system and I can say that we have a LOT of work to do if we are going to prepare lay leaders to assume the leadership and sponsorship roles that the sisters once had. I am convinced that even though we are no longer an immigrant community, our Catholic institutions still have a role to play, especially in a society that is dominated by huge corporations (the recent banking scandals are a case in point). Our educational and health care institutions are both important social forces and means by which we form the laity more deeply in their faith. In all our sponsored ministries, we need to move beyond a false inclusivism that prevents us from saying anything substantive about our own faith tradition or allowing it to make a difference in the way we "do business." This is an entirely new undertaking for us. Catholics have not been accustomed to exercising this kind of responsibility for our ministries, but they are going to have to learn to do so. The good news is that we have found our boards and our senior leaders receptive to serious theological formation.

9 years ago

From my experience this problem began in 1959-1960 when Cardinal Spellman put the Sister of Misericordia on the train back to Montreal. Government monies started about that time and control and power became most important. The woman's expertise was ignored. Lack of concern for the feelings of these women was ignored in several institution. Nurses were well aware of this. Rose Mary Larkin O'Connell Misericordia'53 Faculty '55-59

8 years 11 months ago

The article "And Then There Was One" in the March 16,2009 issue by Daniel P. Sulmasy, O.F.M., M.D. was very enlightening,sad,disturbing. May I say that one of the important factors (an equation that brought success to Catholic Hospitals until the 1980's) and not mentions in the article was the gifted and talented religious women who ran these hospitals, working day and night and weekends to see that the hospitals prospered and the poor were cared for. My aunt was one of these women -- a Sister of Mercy.

8 years 11 months ago

In an age when the most vulnerable are being attacked (the unborn, handicapped and elderly), we need the witness and services of Catholic health care institutions even more than before. In addition to saving Catholic hospitals (or in the place of them), the Church might consider establishing health centers which assist these populations. We need to establish pro-life pregnancy centers, hospices, nursing homes, etc. A time seems to be approaching where the Catholic Church may be the only refuge for these vulnerable populations.

8 years 10 months ago

I am Catholic physician who trained at St. Vincent's. Dr. Sulmasy pulled together a series of events I never connected until reading his article. It is distressing, to say the least. We need to stay optimistic, and continue our work, Christ's work. Things will turn around if we are truly doing Christ's work. In the end,it will be said (borrowing from Bruce Springsteen to Pete Seeger on his 90th birthday) "You outlasted the bastards, man!"

8 years 9 months ago

That was a very powerful article. Having been a RN with the Catholic Medical Center of B/Q for over 40 years the story is so true. My uncle was the chaplin of St. John's Queens for 25 yesrs & I was born there. So much of what I have treasured has been lost. Thank you for telling the entire story.

8 years 9 months ago

dont be to sure that American Catholics and there Hospitals are a reasonable ratio of health professionals and ceos of medical related industries.my personal inquiry into this is from my blacklisting as a pharmacist in 1978.a long time but over 20trillion dollars in health care revenues with diclining vital health statistics..think about 20trillion how much that is and what other industry has had so much revenues,probally a tie with the usa financial industry.there will never be any official data resource on the make up of US HEALTH PROFESSIONALS because that would be irrevoicable prima facae of discriminatiom,it is planned that way.is it coincidence that an analysis of americans richest 1per cent by religion,race,sex,ethnicity is the same make up of who usa health professionals are.???Can we honestly believe that irregardless of 85per cent of the years of the american republic the govt was solvent and not deeply in debt like the last 30years.other than the soviet union which collapsed what national emergency was present that the usa govt would overspend and over borrow so much??AMERICA BECAME A CENTRALLY PLANNED PLUTOCRACY AFTER THE END OF THE GULF WAR.

8 years 7 months ago

I nodded approval on every point laid down by Sulmassy. While in college I was a paramedic and my fiancé was a student nurse at St Clare's. We became engaged in the Chapel at St Clare's. In June 2007, we returned to the Chapel to celebrate our 50th anniversary with 25 children and grandchildren as the hospital was being shut down. It dampened our celebration. I knew that this did not have to happen. I am deeply disappointed.

My immigrant parents were thrilled when I chose Fordham over Columbia and MIT. Later I built and managed one of the largest managed care systems in the USA, covering more than 10 million lives. We saw the lack of vision at Catholic Hospitals, save for the strong leadership of Jack Birkoffer at St. Vincent’s. I remember advising Cardinal O’Connor in the mid 1990s when the archdiocese was struggling. Why the beloved Cardinal O’Connor chose Kettering over St Vincent was a symptom. Catholics are not a political force; they are only vocal subsets of other political hegemonies with non-Catholic agendas, and they find no leadership from the hierarchy. Catholics are not a philanthropic force particularly when endowing the good nuns and brothers who educated us. And finally, why is it politically correct to be anti-Catholic?

penelope carter

7 years 10 months ago

I found the article very informative and clearly undramatic and am grateful for that. I am VERY surprised that ANYONE would be surprised that Catholics do NOT support their own schools and hospitals. This seems to be news ONLY to those with several degrees. I was a COMPLETE and TOTAL product of Catholic Institutions since the first day of my life beginning at SVH to life at the New York Foundling Hospital to a chosen family and then catholic education until the age of 23. If you WANT to know about Catholic Charity............ask a Charity case.

I do not understand ANYONE who thinks they know what the "third leg of Christ's mission" was. I was AMAZED at several comments and the ignorance of so many educated Catholics. First and foremost, John O'Connor had NO other agenda except recruiting a Catholic ARMY (or Navy) via the birth of any and all babies. John O'Connor was a fraud and a fake and a Godless man who OCCUPIED the Archbishop's seat which rightfully belonged to the recommended successor of Terrance Cooke ~ namely, Joseph T. O'Keefe who was EXILED to Syracuse !!!!! That did NOT happen, ergo I HIGHLY recommend ALL NEW YORKERS look to St. Elizabeth Ann Seton. For the mere cost of 250.00 anyone can PURCHASE the collected writings of this SAINT who started it ALL which took TEN YEARS to compile by the Sisters of Charity of New York. You can gain info to this collection via the Sister of Charity of New York website. Unless you know this Saint you know NOTHING of Catholic institutions in America and specifically New York. But again, it's 250.00 and the catholic track record for putting money where your mouth is is not GREAT. However, hope springs eternal and desperation ULTIMATELY will result in having to acquiesce to THIS Saint's intercession because with all these "closings"....God's not likely to give another one anytime soon. Hopefully, this will be printed....although, I know as a "charity case", I am worth little more than the "tax write off" will offer ! Thank you and God be with you !

Jacob Sung Keum

7 years 2 months ago

The landscape is really changing in the health care system in New York state in particular New York City. It was particularly regrettable to see most of our Catholic Hospitals in New York to close specially St Vincents Medical Center.Being myself a practicing physician, I see beyond financial implications for the city.Catholic Hospitals should have continued and Vatican should have supported.In some respects, the cat fights over administration and blame game led to the a Major loss in the battle: the closing of our catholic institutions of vital nature with a unique mission.Now we have only few choices for our patients and in some ways the remaining academic hospitals are not able to fill the void in the quality care. Quality is not only about excellent brand new facilities or institutions filled with famous academic physicians. In the medical practice, the philosophical perspective of that particular institution would define the nature of care further. Without this perspectice in practice, the practice of medicine becomes only mechanical with lack of spiritual value in human dignity. Hospitals become more like financial institutions seeking profit even though they are considered not for profit entities.Catholic institutions should adapt to times however it should forge unity in its management. The health care system should have been organized in more efficient military structure. Any human inefficiencies in the form of disagreeing management can create fundamental problems in the long term viability of a institution.Hope to see the day, when our catholic hospitals can open new doors in New York City with new vision.

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This article also appeared in print, under the headline "Then There Was One," in the March 16, 2009 issue.

Daniel P. Sulmasy, O.F.M., M.D., holder of the Sisters of Charity Chair of Ethics at St. Vincent’s Hospital Manhattan and professor of medicine and director of the Bioethics Institute of New York Medical College, is author of

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